Prevalence, Severity, and Description of Dental Anomalies in Children Treated for Acute Lymphoblastic Leukemia

Purpose: To assess the prevalence and severity of and describe dental anomalies in children treated for acute lymphoblastic leukemia (ALL) under recent Dana-Farber Cancer Institute (DFCI) protocols. Methods: Patients aged between 14 and 25 years old having received a diag- nosis of ALL before the age of 11 years and after September 2000 received clinical and radiographic oral examinations. Results: Dental anomalies were observed in 26 (51.0 percent) of 51 subjects. Microdontia was the most prevalent dental defect (39.2 percent). Impacted permanent second molars were observed in five (9.8 percent) patients. Being age five years or younger at diagnosis significantly increased the prevalence and severity of dental anomalies (P<0.001). Conclusions: Recent DFCI protocols showed a decreased prevalence of dental disturbances. The anomalies observed may still alter the development of the dental arches and occlusion in pediatric ALL survivors. Further research is needed to confirm the association between ALL treatment and permanent second molar impaction.

Statistical analysis of the effluent quality of 231 on-site sanitation facilities in France monitored during a 6-year period

On-site wastewater treatment systems are approved by the French regulation based on the results of platform tests following the European standard NF EN 12566-3. In addition to this approval for the treatment system, at least 90% of outlet concentrations have to be below 30 mg L^-1 for total suspended solids (TSS) and 35 mg L^-1 for biochemical oxygen demand. The aim of this study is to evaluate the effluent quality of these treatment systems on site, i.e. under real operating conditions, and to assess their performances. Between 2011 and 2016, 1,286 treated wastewater samples were taken from 231 on-site sanitation facilities in France. Data collected are heterogeneous and a robust statistical methodology (using a generalized log-linear model) was used to study the effects of four explanatory variables (treatment systems, loading rate, aging and sampling methods) on the distribution of treated wastewater concentrations. The model calculates median outlet concentrations depending on the effects identified. Its application allowed studying and comparing the outlet median concentrations of 21 on-site sanitation systems classified into nine categories and three groups. Four treatment systems out of the 21 monitored showed TSS median outlet concentrations below 10 mg L^-1 and four treatment systems have TSS medians higher than the regulatory threshold of 30 mg L^-1.

Macrophytes are highly sensitive to the herbicide diquat dibromide in test systems of varying complexity

The herbicide diquat dibromide is used in North America to manage nuisance macrophytes. However, its effect on native macrophytes is less clear and it could cause indirect effects on other aquatic biota. This study determined the sensitivity of both native and non-native macrophytes grown in test systems with varying complexity to diquat dibromide applied directly to water following label directions. In an outdoor mesocosm experiment and single species greenhouse concentration-response tests, Elodea canadensis Michx., Myriophyllum spicatum L., Ceratophyllum demersum L. and Hydrocharis morsus-ranae L. were exposed to a range of diquat dibromide concentrations (4.7 - 1153 µg/L), corresponding to 0.4 - 100% of the recommended label rate of the formulated product. The mesocosm experiment contained all four plant taxa in the same system along with caged amphipods (Hyalella azteca Saus.), tadpoles (Lithobates pipiens Schreber), phytoplankton and periphyton; however, this study focuses on the macrophytes only. In both test systems, severe direct effects of diquat dibromide on macrophytes were detected, with almost 100% mortality of all macrophytes in both test systems at 74 µg/L. The most sensitive species in the single species tests, E. canadensis, showed almost 100% mortality at concentrations below the HPLC-based method detection limit of 5 µg/L. Effects occurred very rapidly and showed no difference in severity between native and non-native macrophytes or complexity of test systems. These results suggest that diquat dibromide could be applied at a considerably lower label rate, depending on the characteristics of the waterbody, while still achieving effective control of nuisance macrophytes.

Comparison of the design criteria of 141 onsite wastewater treatment systems available on the French market

New EC standards published in 2009 led to a surge in onsite wastewater treatment systems reaching the European market. Here we summarize their technical aspects and compare them to known values used in centralized wastewater treatment. The paper deals with two types of processes: attached-growth systems (AGS) on fine media and suspended-growth systems (SGS). Covering 141 technical approvals and 36 manufacturers, we compare onsite design criteria against the centralized wastewater design criteria for each process. The systems use a wide range of materials for bacterial growth, from soil, sand or gravel to zeolite, coconut shavings or rockwool cubes, with a huge range of variation in useful surface, from 0.26 m²/PE for one rockwool cube filter to 5 m²/PE for a (traditional system) vertical sand filter. Some rockwool can handle applied daily surface load of 160 g BOD₅/m². SGS design parameters range from 0.025 to 0.34 kg BOD₅ per kg MLVSS/d with hydraulic retention times of 0.28-3.7 d. For clarifier design, water velocity ranges from 0.15 to 1.47 m/h. In the sludge line, sludge storage volume ranges from 0.125 down to just 0.56 m³/PE.

Neural progenitor fate decision defects, cortical hypoplasia and behavioral impairment in Celsr1-deficient mice

The development of the cerebral cortex is a tightly regulated process that relies on exquisitely coordinated actions of intrinsic and extrinsic cues. Here, we show that the communication between forebrain meninges and apical neural progenitor cells (aNPC) is essential to cortical development, and that the basal compartment of aNPC is key to this communication process. We found that Celsr1, a cadherin of the adhesion G protein coupled receptor family, controls branching of aNPC basal processes abutting the meninges and thereby regulates retinoic acid (RA)-dependent neurogenesis. Loss-of-function of Celsr1 results in a decreased number of endfeet, modifies RA-dependent transcriptional activity and biases aNPC commitment toward self-renewal at the expense of basal progenitor and neuron production. The mutant cortex has a reduced number of neurons, and Celsr1 mutant mice exhibit microcephaly and behavioral abnormalities. Our results uncover an important role for Celsr1 protein and for the basal compartment of neural progenitor cells in fate decision during the development of the cerebral cortex.

Prenatal diagnosis and prognosis of accelerated idioventricular rhythm

OBJECTIVES

As postnatal identification of accelerated idioventricular rhythm (AIVR) relies on specific electrocardiographic patterns, prenatal diagnosis of this condition is challenging and its true incidence is unknown. The objectives of this study were to evaluate the performance of prenatal ultrasonography in identifying intrauterine cardiocirculatory events linked to specific electrocardiographic signs of postnatal AIVR, including left or right ventricular origin, and to assess the prenatal prognosis of this arrhythmia.

METHODS

We reviewed Doppler tracings from the superior vena cava/ascending aorta (SVC/Ao), ductus venosus (DV), ductus arteriosus (DA) and aortic isthmus (AoI), as well as simultaneous M-mode recordings of septal and left ventricular wall motions of fetuses diagnosed with AIVR from January 2004 to December 2014.

RESULTS

Three cases of AIVR were identified among 27 912 fetuses. SVC/Ao Doppler flow recordings revealed atrioventricular dissociation (ventricular rates within 20% of atrial rates) in all three fetuses and episodes of isorhythmic atrioventricular dissociation in one, while M-mode confirmed normal left ventricular shortening fraction in all cases. Fusion beats were observed on AoI tracing in one fetus, while simultaneous recordings of AoI and DA revealed signs of right bundle branch block in one case and left bundle branch block in the other two. On DV Doppler recordings, retrograde a-waves in the presence of simultaneous atrial and ventricular contractions were observed in all three fetuses, leading to an increase in central venous pressure in all and hydrops fetalis in two cases without evidence of ventricular dysfunction.

CONCLUSIONS

Echocardiographic criteria required for postnatal diagnosis of AIVR can be documented in utero using specific ultrasonographic approaches. During fetal life, AIVR may not be a benign entity. Hydrops fetalis is frequently associated with AIVR because of increase in central venous pressure related to simultaneous atrioventricular contractions; thus, the ultrasonographic investigation protocol of fetuses with unexplained hydrops fetalis should aim at ruling out AIVR and include Doppler flow recordings in SVC/Ao, DV, AoI, DA and umbilical vein. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Assessment of wetland/upland vegetation communities and evaluation of soil-plant contamination by polycyclic aromatic hydrocarbons and trace metals in regions near oil sands mining in Alberta

Oil sands mining in Alberta, Canada, has been steadily increasing over the last 50years. The extent to which the surrounding vegetation has been altered/contaminated by pollutants released during bitumen extraction has not been a focus of oil sands environmental monitoring efforts. The objectives of this study were to assess plant species richness and composition in wetlands and uplands in the vicinity of oil sands mining areas and to measure levels of contamination of trace metals and polycyclic aromatic hydrocarbons (PAHs) in soils and plants. Twenty-two sites were selected in three locations: near to (OS, n=7), West (n=7), and East (n=8) of oil sands mining operations. Aboveground plant species were inventoried and soil was collected for a seedbank study. Soils and plants were collected for analyses of 28 metals and 40 parent and alkylated PAHs. Plant species richness and composition differed significantly among locations. More species were found in the OS sites, many of them being non-native, than in East and West sites, which contained almost exclusively native perennials. PAH levels were significantly higher in OS sites, and were mostly comprised of alkylated PAHs. Patterns of PAH distribution indicated contamination from bitumen/petroleum in four sites; other combustion types may have affected five additional sites at different levels. Metals were also elevated in OS sites. Metal levels were significantly correlated with distance to upgrader facilities. Ratios of some metals in soil vs. above- and belowground plant parts were significantly higher in West and East than in OS sites, likely due in part to pH as soil was acidic at the East and West locations but alkaline at OS sites. This study showed that sites located near oil sands mining operations were contaminated with PAHs and metals, and that the vegetation composition at these sites greatly differed from less disturbed areas.

Evaluating trivalent chromium toxicity on wild terrestrial and wetland plants

Elevated chromium levels in soil from mining can impact the environment, including plants. Mining of chromium is concentrated in South Africa, several Asian countries, and potentially in Northern Ontario, Canada, raising concerns since chromium toxicity to wild plants is poorly understood. In the first experiment, concentration-response tests were conducted to evaluate effects of chromium on terrestrial and wetland plants. Following established guidelines using artificial soil, seeds of 32 species were exposed to chromium (Cr(3+)) at concentrations simulating contamination (0-1000 mg kg(-1)). This study found that low levels of chromium (250 mg kg(-1)) adversely affected the germination of 22% of species (33% of all families), while higher levels (500 and 1000 mg kg(-1)) affected 69% and 94% of species, respectively, from 89% of the families. Secondly, effects on seedbanks were studied using soil collected in Northern Ontario and exposed to Cr(3+) at equivalent concentrations (0-1000 mg kg(-1)). Effects were less severe in the seedbank study with significant differences only observed at 1000 mg kg(-1). Seeds exposed to Cr(3+) during stratification were greatly affected. Seed size was a contributing factor as was possibly the seed coat barrier. This study represents an initial step in understanding Cr(3+) toxicity on wild plants and could form the basis for future risk assessments.

Evaluating trivalent chromium toxicity on wild terrestrial and wetland plants

Elevated chromium levels in soil from mining can impact the environment, including plants. Mining of chromium is concentrated in South Africa, several Asian countries, and potentially in Northern Ontario, Canada, raising concerns since chromium toxicity to wild plants is poorly understood. In the first experiment, concentration-response tests were conducted to evaluate effects of chromium on terrestrial and wetland plants. Following established guidelines using artificial soil, seeds of 32 species were exposed to chromium (Cr(3+)) at concentrations simulating contamination (0-1000 mg kg(-1)). This study found that low levels of chromium (250 mg kg(-1)) adversely affected the germination of 22% of species (33% of all families), while higher levels (500 and 1000 mg kg(-1)) affected 69% and 94% of species, respectively, from 89% of the families. Secondly, effects on seedbanks were studied using soil collected in Northern Ontario and exposed to Cr(3+) at equivalent concentrations (0-1000 mg kg(-1)). Effects were less severe in the seedbank study with significant differences only observed at 1000 mg kg(-1). Seeds exposed to Cr(3+) during stratification were greatly affected. Seed size was a contributing factor as was possibly the seed coat barrier. This study represents an initial step in understanding Cr(3+) toxicity on wild plants and could form the basis for future risk assessments.

Oxygen profile and clogging in vertical flow sand filters for on-site wastewater treatment

13 million people (about 20% of the population) use on-site wastewater treatment in France. Buried vertical sand filters are often built, especially when the soil permeability is not sufficient for septic tank effluent infiltration in undisturbed soil. Clogging is one of the main problems deteriorating the operation of vertical flow filters for wastewater treatment. The extent of clogging is not easily assessed, especially in buried vertical flow sand filters. We suggest examining two possible ways of detecting early clogging: (1) NH4-N/NO3-N outlet concentration ratio, and (2) oxygen measurement within the porous media. Two pilot-scale filters were equipped with probes for oxygen concentration measurements and samples were taken at different depths for pollutant characterization. Influent and effluent grab-samples were taken three times a week. The systems were operated using batch-feeding of septic tank effluent. Qualitative description of oxygen transfer processes under unclogged and clogged conditions is presented. NH4-N outlet concentration appears to be useless for early clogging detection. However, NO3-N outlet concentration and oxygen content allows us to diagnose the early clogging of the system.

Note: Spin-exchange optical pumping in a van

The advent of spin-hyperpolarization techniques designed to overcome the sensitivity issue of nuclear magnetic resonance owing to polarization transfer from more ordered systems has recently raised great enthusiasm. However, the out-of-equilibrium character of the polarization requires a close proximity between the area of production and the site of use. We present here a mobile spin-exchange optical pumping setup that enables production of laser-polarized noble gases in a standalone mode, in close proximity to hospitals or research laboratories. Only compressed air and mains power need to be supplied by the host laboratory.

3D-printed system optimizing dissolution of hyperpolarized gaseous species for micro-sized NMR

Dissolution of hyperpolarized species in liquids of interest for NMR is often hampered by the presence of bubbles that degrade the field homogeneity. Here a device composed of a bubble pump and a miniaturized NMR cell both fitted inside the narrow bore of an NMR magnet is built by 3D printing. (129)Xe NMR experiments performed with hyperpolarized xenon reveal high and homogeneous dissolution of the gas in water.

A doubly responsive probe for the detection of Cys4-tagged proteins

A biosensor for bimodal detection of recombinant Cys-tagged proteins via fluorescence and hyperpolarized ¹²⁹Xe NMR is presented. Interaction with a peptide containing the motif Cys–Cys–X–X–Cys–Cys activates both fluorescence and NMR responses.

Vertical flow constructed wetlands subject to load variations: an improved design methodology connected to outlet quality objectives

This study surveyed four campsites and four rural villages of major tourist interest, called tourist-interest or ti-villages, that were monitored for several years, generating over 70 performance balances for vertical flow constructed wetlands (VFCWs) that were intentionally scaled down for experimental trials. The wastewater effectively qualifies as domestic sewage, although relatively concentrated, with the campsites presenting particularly high nitrogen concentrations (122 gTKN L(-1)) (TKN: total Kjeldahl nitrogen). The applied daily loads were also particularly high, with some combinations of load parameters (hydraulic load, organic matter, TKN) leading to 400% overloading. Even under those drastic conditions, the quality of effluent remained excellent on the characteristic organic matter parameters, with removal performances always over 85%. Analysis of the dataset points to two major design thresholds: for campsites, in order to maintain a 73% nitrification rate even at the height of the summer season, the load applied onto the first stage filter in operation could achieve up to 600 gCOD m(-2) day(-1) (COD: chemical oxygen demand). For tourist-interest villages, in order to maintain an 85% nitrification rate, the load applied onto the second stage filter in operation could achieve up to 22 gTKN m(-2).day(-1). Here, VFCWs were demonstrated to robustly handle a massive increase in loads applied, providing the construction and operation stringently follow design standards and practices.

Herbicide impact on non-target plant reproduction: what are the toxicological and ecological implications?

Declining plant diversity and abundance have been widely reported in agro-ecosystems of North America and Europe. Intensive use of herbicides within cropfields and the associated drift in adjacent habitats are partly responsible for this change. The objectives of this work were to quantify the phenological stages of non-target plants in in-situ field situations during herbicide spray and to compare plant susceptibility at different phenological stages. Results demonstrated that a large number of non-target plants had reached reproductive stages during herbicide spray events in woodlots and hedgerows, both in Canada and Denmark where vegetation varies considerably. In addition, delays in flowering and reduced seed production occurred widely on plants sprayed at the seedling stage or at later reproductive periods, with plants sprayed at reproductive stages often exhibiting more sensitivity than those sprayed as seedlings. Ecological risk assessments need to include reproductive endpoints.

Natural-killer cell-mediated cytotoxicity of blood-lymphocytes from patients with malignant mesothelioma treated by intrapleural interleukin-2

The most impressive biological effect of recombinant Interleukin-2 (rIL-2) is the generation of nonspecific killer cells that have lytic activity for a variety of tumor cells. Numerous studies have shown that these non specific killer cells might be of NK cell lineage even though they are different from resident NK-cell. We have examined the kinetics of the NK cell-mediated cytotoxicity of blood lymphocytes in patients after intrapleural rIL-2 administered for the treatment of pleural cancer. Escalating doses of rIL-2 were administered by intrapleural route to treat 11 patients with malignant pleural effusions due to malignant pleural mesothelioma (4 stage I, 4 stage II, 2 stage III, 1 stage IV). Two patients received respectively 3 cycles and 2 cycles of treatment. Peripheral blood lymphocyte cytotoxicity was assessed by an in vitro, chromium release microcytotoxicity assay against K562 cell line. Preliminary results indicate: (i) an important and prolonged increase in the cytotoxic response of blood lymphocytes in all patients but one having a clinical response and (ii) a lack of cytotoxicity or a baseline cytotoxic response of blood lymphocytes in all patients but one with no clinical response. These results likely point out the significance of NK-activity in the IL-2-induced antitumoral response and the interest of this in vitro assay for screening patients for further cycles of treatment.

Phytotoxicity testing for herbicide regulation: shortcomings in relation to biodiversity and ecosystem services in agrarian systems

The purpose of this paper is to present current knowledge on methods employed to perform phytotoxicity tests and risk assessments and to highlight shortcomings in relation to biodiversity and ecosystem services. Ecosystem services are benefits provided to humankind by a multitude of organisms present in natural ecosystems. Several studies were conducted between 2001 and 2010 aimed at investigating some of the deficiencies in phytotoxicity testing (new and existing data are presented). Herbicide toxicity responses were similar when comparing a suite of crop versus wild species. However, the validity of the evaluation was limited because of the narrow types of species tested. The number of species tested, currently set between six and ten, appears insufficient. The trait-based approach (i.e. the use of plant attributes to predict species sensitivity to toxicants) can be used to improve species selection. This approach puts more emphasis on the shared biological characteristics that affect plant function within ecological communities rather than on plant phylogeny. Results presented showed that further studies are needed. In test guidelines, protocols require that crop species be sprayed as young vegetative plants, which is assumed to be the most sensitive growth stage to herbicides. In contrast, during herbicide spray, herbicides may reach non-target plants that are at various phenological stages. Several studies demonstrated that plants may be at greater risk when contamination occurs at the reproductive stage. No data on long-term effects, plant recovery or on effects on reproductive stages are requested in current guidelines. Preliminary evidence suggests that this may be an important aspect to consider in risk assessment. In addition, herbicide impacts on plant community diversity as well as biodiversity at other trophic levels have been demonstrated in only a limited number of studies and therefore should warrant more attention in risk assessment.

The value of woody hedgerows for moth diversity on organic and conventional farms

Habitat destruction and degradation are important drivers of biodiversity loss within agro-ecosystems. However, little is known about the effect of farming practices and the value of woody hedgerows on Lepidoptera in North America. The purpose of this work was to study moth diversity in woody hedgerows and croplands of organic and conventional farms. In addition, the influence of vegetation composition and abiotic variables on species richness, abundance, and composition was examined. Moths were sampled with light traps during six weeks in the summer of 2001. Vegetation data and abiotic variables were obtained for all sites. In total, 26,020 individuals from 12 families and 408 species were captured. Most species were uncommon. Only 35 species included >100 individuals while for 71% of species <10 individuals were found. The Noctuidae represented 221 species and 85% of all individuals captured. Woody hedgerows harbored more species and in greater number than croplands. There was no significant difference in moth diversity between organic and conventional farms, except that the Notodontidae were significantly more species rich in organic than in conventional sites. Results show that species richness, abundance, and composition were greatly influenced by habitat types (hedgerow versus crop field) and abiotic variables (minimum temperature which was correlated to moon illumination, rainfall, and cloud cover). Moth species composition was significantly correlated to vegetation composition. This study broadens our understanding of the factors driving moth diversity and expands our knowledge of their geographic range. The maintenance of noncrop habitats such as woody hedgerows within agro-ecosystems seems paramount to preserving the biodiversity and abundance of many organisms, including moths.

[Groundwater quality in two arid areas of Morocco: impact of pollution on biodiversity and paleogeographic implications]

The biodiversity and the quality of subterranean waters have been comparatively studied in the Haouz plain near Marrakesh and in the Tafilalet, in south-eastern Morocco. For this purpose, physicochemical and faunistic analyses were carried out on the water of ten wells and springs located in the area of Marrakesh, and in Errachidia area respectively. In the wells of Marrakesh, the average stygobiologic diversity is relatively high in the wells located upstream the dumping from the city where the ground water presents low contents of nitrates and orthophosphates. In contrast, the wells located in the spreading zone of Marrakesh wastewaters are characterized by the scarcity or the absence of stygobitic species; in these latter wells, the water is highly polluted. It is rich in nitrates, nitrites, ammonium, and the conductivity is rather high. In the area of Errachidia the faunistic inventory gathers some ten species, some of which are living in hot springs. The subterranean water is highly mineralised. In the two studied areas, the biodiversity decreases when well water is locally polluted, and the subterranean fauna completely disappears if the degree of contamination is important. This relation between the biodiversity and water quality which had already appeared in surface water, is confirmed within the wells of Marrakech. The groundwater fauna of both two areas presents similarities in relation to their geological history, mainly the various marine cycles of marine transgressions-regressions, which were at the origin of the settlement of the ancestors of the extant species, and the Atlasic orogenesis which separated the common ancestral populations into two separated stocks, involving a different evolution of the ancestors and a resulting speciation by vicariance.

The French National Mesothelioma Surveillance Program

OBJECTIVES

The French National Mesothelioma Surveillance Program (NMSP) was established in 1998 by the National Institute for Health Surveillance (InVS). Its objectives are to estimate the trends in mesothelioma incidence and the proportion attributable to occupational asbestos exposure, to help improve its pathology diagnosis, to assess its compensation as an occupational disease, and to contribute to research.

METHODS

The NMSP records incident pleural tumours in 21 French districts that cover a population of approximately 16 million people (a quarter of the French population). A standardised procedure of pathological and clinical diagnosis ascertainment is used. Lifetime exposure to asbestos and to other factors (man made mineral fibres, ionising radiation, SV40 virus) is reconstructed, and a case-control study was also conducted. The proportion of mesothelioma compensated as an occupational disease was assessed.

RESULTS

Depending on the hypothesis, the estimated number of incident cases in 1998 ranged from 660 to 761 (women: 127 to 146; men: 533 to 615). Among men, the industries with the highest risks of mesothelioma are construction and ship repair, asbestos industry, and manufacture of metal construction materials; the occupations at highest risk are plumbers, pipe-fitters, and sheet-metal workers. The attributable risk fraction for occupational asbestos exposure in men was 83.2% (95% CI 76.8 to 89.6). The initial pathologist's diagnosis was confirmed in 67% of cases, ruled out in 13%, and left uncertain in the others; for half of the latter, the clinical findings supported a mesothelioma diagnosis. In all, 62% applied for designation of an occupational disease, and 91% of these were receiving workers' compensation.

CONCLUSIONS

The NMSP is a large scale epidemiological surveillance system with several original aspects, providing important information to improve the knowledge of malignant pleural mesothelioma, such as monitoring the evolution of its incidence, of high risk occupations and economic sectors, and improving pathology techniques.

Nuevas tendencias de la endocarditis pediátrica

OBJECTIVES

To evaluate the epidemiology, etiology and outcome of endocarditis in a cohort of pediatric patients and to compare the main characteristics with our previous experience.

MATERIAL AND METHODS

Patients aged less than 18 years of age diagnosed with endocarditis at the Sainte-Justine Hospital, University of Montreal between 1-1986 and 12-2000 were studied. The recent case series was compared with our previous experience from 1960-1985.

RESULTS

Fifty-six children with endocarditis were included in the 1986-2000 series: 35 children with congenital heart disease, 15 with serious underlying disease and six healthy children. The mean age was 7 years and 10 months. Fifty-four percent of the patients were boys. The incidence of endocarditis increased from 1.5 cases/year in the 1986-2000 series to 4 cases/year in the 1986-2000 series. In the 1986-2000 series, 10 (17.9 %) patients had a central catheter. Sixteen (28.6 %) patients had a vascular prosthesis. Blood cultures were positive in 50 patients (89 %): Streptococci were found in 48 % of the patients and Staphylococci in 34 %. Echocardiography was positive in 36 of 55 patients (65.4 %). All children were treated with intravenous antibiotics for a mean of 43 +/- 15 days. There were no recurrences. Significant morbidity developed in 26 patients (46 %). Embolic phenomena were seen in 11 children (20 %). Twelve patients (21 %) needed surgery. Of the six healthy children, five developed complications. Overall, seven children (12.5 %) died; all were older than 6 years of age. Comparing our experience from 1960-1985 with that from 1986-2000 revealed that morbidity decreased from 85.7 % to 46.4 % and mortality decreased from 27 % to 12.5 %.

CONCLUSIONS

Physicians must recognize that children with underlying immunodeficiency and those with central catheters have an increased risk of endocarditis. Healthy children with endocarditis have a greater risk of complications. Morbidity and mortality due to endocarditis has diminished considerably in recent years.

Waste stabilisation ponds in France: state of the art and recent trends

Waste stabilisation ponds represent 20% of the total number of wastewater treatment plants in France. Practical expertise acquired during these last 20 years has led to modification in the design of the first facultative basin of WSP systems. Its active surface area is now dimensioned at 6 m2(p.e.)(-1) in order to limit the risk of malfunctioning. The cumulated surface of the 2nd and 3rd basin is maintained at 5 m2(p.e.)(-1). Another practical point is also that WSPs must receive mainly diluted influents. Globally, the plants are on average far from their nominal loadings, which explains why the first sludge removals took place on average 13 years after being put in operation. Based on a representative sample of plants, i.e. 1 5% of the French WSPs, it has been possible to estimate the time, material means and cost needed for sludge removal as well as the amount of sludge accumulated. The sludge removed at the 1st yields on average 110 L (p.e.)(-1) which represents 12 kg DM (p.e.)(-1). The current trend of increasing the quality levels necessary for discharge into sensitive receiving bodies has led to adaptive solutions of polishing treatments by intermittent sand filter systems with or without the plantation of reeds.

How to treat raw sewage with constructed wetlands: an overview of the French systems

The development of vertical flow constructed wetlands treating raw wastewater in France has proved to be very successful over the last 20 years. In view of this a survey was carried out on more than 80 plants in order to study their performance and correct the design if necessary. This study shows that such systems perform well in terms of respecting the goals of both low level outlet COD and SS and nitrification. Pollutant removal performance in relation to the loads handled and the specific characteristics of the plants were investigated. Nitrification is shown to be the most sensitive process in such systems and performance in relation to sizing is discussed. Such systems, if well designed, can achieve an outlet level of 60 mg L(-1) in COD, 15 mg L(-1) in SS and 8 mg L(-1) in TKN with an area of 2 - 2.5 m2.PE(-1). The sludge deposit on the first stage must be removed after about 10-15 years.

[Noncompacted cardiomyopathy of the left ventricule]

In response to a recent review on the role of MRI in the evaluation of cardiomyopathies, we wished, through a clinical example, to focus the attention on noncompacted cardiomyopathy of the left ventricule, an under-diagnosed entity at the border of pediatric and adult imaging, because of its congenital nature but of late presentation.

Toxicity testing of fifteen non-crop plant species with six herbicides in a greenhouse experiment: implications for risk assessment

Estimation of risk to plants not targeted by herbicides when used in agricultural or forestry situations requires appropriate data on multiple species. Currently, many questions remain unresolved as to the adequate type and number of species to be tested. This paper presents the result of a unique greenhouse experiment where testing was performed with 15 non-crop plant species sprayed with 6 herbicides. The herbicides were chosen because of their different modes of action and because they are widely used in several countries. The plants favoured were species commonly found in field margins of Europe and/or North America. This dataset (called thereafter Danish/Canadian) was compared to the crop species that had been submitted to the US EPA for the same herbicides. In general, the selected plant species in the Danish/Canadian database were easy to grow and maintain in the greenhouse. The Danish/Canadian plants were overall more sensitive than the species tested in the US EPA data, yielding to a 5% protection threshold (HC5(50)) that was always more conservative. There was a large variability in plant responses among herbicides. Recommendations are provided on species that should and should not be used for risk assessment of non-target plants.

Management of fetal tachyarrhythmia based on superior vena cava/aorta Doppler flow recordings

OBJECTIVE

To evaluate a management protocol of fetal supraventricular tachycardia (SVT) based on prior identification of the underlying mechanism.

DESIGN AND SETTING

Prospective study in a mother-child tertiary university centre.

PATIENTS

During a consecutive 36 month period, 18 fetuses with sustained SVT underwent a superior vena cava/ascending aorta (SVC/AA) Doppler investigation in an attempt to determine the atrioventricular (AV) relation and to treat the arrhythmia according to a pre-established management protocol.

MAIN OUTCOME MEASURE

Rate of conversion to sinus rhythm.

RESULTS

Seven fetuses had short ventriculoatrial tachycardia, five of these with a 1:1 AV conduction suggesting re-entrant tachycardia. The first choice drug was digoxin and all were converted. One fetus had AV dissociation leading to the diagnosis of junctional ectopic tachycardia, which was resistant to digoxin and sotalol; amiodarone achieved postnatal conversion. One fetus had SVT and first or second AV block; the diagnosis was atrial ectopic tachycardia (AET), which responded to sotalol given as a drug of first choice. Seven fetuses had long ventriculoatrial tachycardia: one with sinus tachycardia (no treatment), one with permanent junctional reciprocating tachycardia (PJRT), and three with AET. The first choice drug was sotalol and all were converted. One AET was classified postnatally as PJRT. Six fetuses had intra-atrial re-entrant tachycardia: five with 2:1 AV conduction and one with variable block. The first choice drug was digoxin. Conversion was achieved in all but one, who died after birth from advanced cardiomyopathy.

CONCLUSION

The electrophysiological mechanisms of fetal SVT can be clarified with SVC/AA Doppler. The proposed management protocol has so far yielded a good rate of conversion to sinus rhythm.

Group therapy for pathological gamblers: a cognitive approach

This study evaluated the efficacy of a group cognitive treatment for pathological gambling. Gamblers, meeting DSM-IV criteria for pathological gambling, were randomly assigned to treatment (N=34) or wait-list control (N=24) conditions. Cognitive correction techniques were used first to target gamblers' erroneous perceptions about randomness, and then to address issues of relapse prevention. The dependent measures used were the DSM-IV criteria for pathological gambling, perceived self-efficacy, gamblers' perception of control, desire to gamble, and frequency of gambling. Post-treatment results indicated that 88% of the treated gamblers no longer met the DSM-IV criteria for pathological gambling compared to only 20% in the control group. Similar changes were observed on all outcome measures. Analysis of data from 6-, 12- and 24-month follow-ups revealed maintenance of therapeutic gains. Recommendations for group interventions are discussed, focusing on the cognitive correction of erroneous perceptions toward the notion of randomness.

Predictors of handicap situations following post-stroke rehabilitation

PURPOSE

Many stroke survivors have to cope with impairments and disabilities that may result in the occurrence of handicap situations. The purpose of the study was to explore bio-psycho-social predictors of handicap situations six months after discharge from an intensive rehabilitation programme.

METHODS

At discharge from a rehabilitation programme, participants were evaluated with instruments measuring motor, sensory, cognitive, perceptual, affective and psychosocial impairments and disabilities that may play a role in the development of handicap. Some other demographic and clinical variables, and those related to rehabilitation, were also collected. Six months later, they were re-assessed in their own environment in order to document their handicap level with the Assessment of Life Habits (LIFE-H).

RESULTS

One hundred and thirty-two stroke patients participated in the discharge evaluation and 102 of them also participated in the handicap measurement. Relationships between handicap level and impairments and disabilities were all statistically significant. Multiple regression analyses indicated that affect, lower extremity co-ordination, length of stay in rehabilitation, balance, age and comorbidity at the end of an intensive rehabilitation programme are the best predictors of handicap situations six months later (adjusted R(2): 68.1%).

CONCLUSIONS

In spite of its exploratory nature, this study revealed that, among a substantial number of personal characteristics, some were more related to a handicap measure and have greater predictive value. Other studies should be carried out to validate these findings and to consider more environmental factors in order to better understand factors related to the development of handicap situations.

Talcage by medical thoracoscopy for primary spontaneous pneumothorax is more cost-effective than drainage: a randomised study

Simple thoracoscopic talcage (TT) is a safe and effective treatment of primary spontaneous pneumothorax (PSP). However, its efficacy has not previously been estimated in comparison with standard conservative therapy (pleural drainage (PD)). In this prospective randomised comparison of two well-established procedures of treating PSP requiring at least a chest tube, cost-effectiveness, safety and pain control was evaluated in 108 patients with PSP (61 TT and 47 PD). Patients in both groups had comparable clinical characteristics. Drainage and hospitalisation duration were similar in TT and PD patients. There were no complications in either group. The immediate success rate was different: after prolonged drainage (>7 days), 10 out of 47 PD patients, but only 1 out of 61 TT patients required a TT as a second procedure. Total costs of hospitalisation including any treatment procedure were not significantly different between TT and PD patients. Pain, measured daily by visual analogue scales, was statistically higher during the first 3 days in TT patients but not in those patients receiving opiates. One month after leaving hospital, there was no significant difference in residual pain or full working ability: 20 out of 58 (34%) versus 10 out of 47 (21%) and 36 out of 61 (59%) versus 26 out of 39 (67%) in TT versus PD groups, respectively. After 5 yrs of follow-up, there had been only three out of 59 (5%) recurrences of pneumothorax after TT, but 16 out of 47 (34%) after conservative treatment by PD. Cost calculation favoured TT pleurodesis especially with regard to recurrences. In conclusion, thoracoscopic talc pleurodesis under local anaesthesia is superior to conservative treatment by chest tube drainage in cases of primary spontaneous pneumothorax that fail simple aspiration, provided there is efficient control of pain by opioids.

Chrysotile and tremolite asbestos fibres in the lungs and parietal pleura of Corsican goats

BACKGROUND AND AIMS

Environmental exposures to chrysotile and tremolite from the soil cause pleural plaques and mesothelioma in northeast Corsica. Goats grazing in the contaminated areas inhale asbestos fibres. We used this natural animal model to study whether these exposures actually result in increased fibre burdens in the lungs and parietal pleura.

METHODS

Ten goats from areas with asbestos outcrops and two from other areas were slaughtered. Fibre content of lung and parietal pleural samples was determined by analytical transmission electron microscopy.

RESULTS

Both chrysotile and tremolite fibres were detected. In the exposed goats, the geometric mean concentrations of asbestos fibres longer than 1 microm were 0.27 x 10(6) fibres/g dry lung tissue and 1.8 x 10(6) fibres/g dry pleural tissue. Asbestos fibres were not detected in the lungs of the two control goats. Chrysotile fibres shorter than 5 microm were predominant in the parietal pleura. Tremolite fibres accounted for 78% and 86% of the fibres longer than 5 microm in lung and parietal pleural samples, respectively.

CONCLUSIONS

Environmental exposure in northeast Corsica results in detectable chrysotile and tremolite fibre loads in the lung and parietal pleura of adult goats. Tremolite fibres of dimensions with a high carcinogenic potency are detected in the parietal pleura.

Estimation of the incidence of pleural mesothelioma according to death certificates in France

BACKGROUND

The number of cases of pleural mesothelioma in France has varied substantially according to methods of assessment.

MATERIALS AND METHODS

We collected information from certifying physicians about 316 subjects who died between 1 July 1992 and 30 June 1993 in three regions of France with a cause of death coded as ICD-9 category 163. The ICD codes selected as the cause of death for 178 deaths between 1 January 1987 and 31 December 1992 histologically confirmed and diagnosed as pleural mesothelioma by an expert committee were examined. Finally, we used this information to estimate the number of deaths from pleural mesothelioma in France in 1992.

RESULTS

In Part I, 45% (men: 54%; women: 28%) of the cases coded as ICD-9 section 163 were definitely or probably mesothelioma; 18% (men: 16%; women: 21%) possibly mesothelioma; and 37% (men: 30%; women: 51%) other tumors, primarily adenocarcinoma metastases. In Part II, 74% of the confirmed pleural mesotheliomas were coded in category 163 (men: 75%; women: 70%). Extrapolation nationwide indicated that 902 deaths were coded as ICD-9 163 in 1992: 521 cases involved definite or probable mesothelioma and 724 definite, probable, and possible cases.

CONCLUSIONS

The analysis of this sample suggests that estimating the number of mesothelioma cases from the cause-of-death statistics may overestimate their incidence, but that death certificates appeared to report the diagnosis of histologically confirmed mesothelioma accurately.

Anaesthetic management of an adolescent for scoliosis surgery with a Fontan circulation

Advances in the treatment of congenital heart disease have led to a new group of adolescents or adults patients with cardiac anomalies. The anaesthetic management of these patients can be challenging especially when they are scheduled for major noncardiac surgery inducing haemodynamic instability. We report the case of a 14-year-old boy scheduled for posterior spinal fusion for idiopathic scoliosis who underwent a Fontan operation in infancy for pulmonary atresia with right ventricle hypoplasia. The preoperative investigations and the anaesthetic management are described.

Modelling of a recirculating granular medium filter's processes

The effluents of French small farm factories will soon be submitted to regulation. Only a few treatment techniques are available to deal with these kind of effluent (high concentration and small daily volumes). To allow the treatment, in the particular economic context of small food processing industries, Cemagref is trying to adapt a treatment based on attached growth cultures on fine media, a system known to be easy to operate and relatively inexpensive. A model, based on four sub-models (hydrodynamic characteristics, oxygen transport, solute transport in the mobile and immobile phases and bacterial evolution) describes this process. Based on wastewater concentration, hydraulic load, applied organic loads, feeding/rest cycles and recycling phases number, this model predicts: eliminated organic loads and the discharge concentration as a function of time, oxygen and biomass contents as a function of time and depth. The determination of the model's parameters is based on a comparison between simulations and performances achieved on experimental columns. This model would be helpful in sizing full-scale filters treating different types of agro-food wastewater. The aim of this article is to present the model's structure, to give all parameter values and to compare the simulations with the results obtained on pilot and full scale plants.

Use of recycling through medium size granular filters to treat small food processing industry effluents

Currently there are no suitable wastewater treatment systems for effluents from small food processing industries (dairy, cheese, wine production). Such raw sewages are characterized by high organic matter concentrations (about 10 g COD L-1) and relatively low daily volumes (about 2 m3). An adaptation of attached-growth cultures on fine media processes, known to be easy and inexpensive to use, could fit both the technical and economical context of those industries. Coarser filter particle size distributions than those normally used allow a better aeration and reduce clogging risk. The transit time of the effluent through the porous filter materials is shortened and requires recycling to increase the contact time between the biomass and the substrate. A pilot plant was built to compare the efficiency of two kinds of filter materials, gravel (2-5 mm) and pozzolana (3-7 mm). Two measurement campaigns were undertaken on a full-scale unit dealing with cheese dairy effluents. Both pilot-scale and full-scale plants show high COD removal rates (> 95%). Pilot-scale experiments show that accumulation of organic matter leads to the clogging of the recycling filter. To prevent early clogging, a better definition of feeding cycles is needed.

Cognitive treatment of pathological gambling

This study evaluated the efficacy of a cognitive treatment package for pathological gambling. Sixty-six gamblers, meeting DSM-IV criteria for pathological gambling, were randomly assigned to treatment or wait-list control conditions. Cognitive correction techniques were used first to target gamblers' erroneous perceptions about randomness and then to address issues of relapse prevention. The dependent measures used were the South Oaks Gambling Screen, the number of DSM-IV criteria for pathological gambling met by participants, as well as gamblers' perception of control, frequency of gambling, perceived self-efficacy, and desire to gamble. Posttest results indicated highly significant changes in the treatment group on all outcome measures, and analysis of data from 6- and 12-month follow-ups revealed maintenance of therapeutic gains. Recommendations for clinical interventions are discussed, focusing on the cognitive correction of erroneous perceptions toward the notion of randomness.

A national network for the tele-education of Canadian residents in pediatric cardiology

A trial of 11 video-conferenced teaching sessions for residents in pediatric cardiology was performed by the 7 training programs in Canada in order to share expertise in specialized areas, to expose trainees to educational telemedicine, and to acquaint residents with other programs and personnel. Topics included cardiac pathology, arrhythmias, magnetic resonance imaging, fetal physiology, pulmonary hypertension, and cardiomyopathy. The sessions were evaluated by 93 residents by questionnaire for content and technology. Session content was highly rated. Videoconference picture quality was highly rated, but sound quality and visual aids were rated as neutral or unsatisfactory by a significant minority, related to problems with several early sessions, subsequently corrected. 60% of respondents rated the videoconferences as good as live presentations. Presenters were generally satisfied although they required some adjustments to videoconferencing. The average cost per session was $700 Canadian. Videoconferencing of resident educational sessions was generally well accepted by most presenters and residents, and the trial has formed the basis for a national network. Adequate organizational time, and careful attention to audiovisual needs, are most important. Videoconference guidelines are suggested for presenters based on this experience.

Choice of the sand for sand filters used for secondary treatment of wastewater

In a range from 100 to about 1,000 People Equivalent (PE), Secondary Wastewater Sand Filters (SWSF) are used by a lot of rural communities in France. A series of case studies however point out that several criteria concerning global and detailed design and implementation of these systems have to be approached scientifically, in order to obtain the expected results on a long-term basis. The choice of the sand constituting the infiltration bed, core of the biological reactor, is of course one of the key elements and is the main subject of this article. It must have a sufficient initial permeability in order to ensure an adapted infiltration speed, after colonisation by the purifying biomass. The d10 fines content and degree of uniformity mainly control this permeability. The quarry or the aggregate extractor, who masters his production this way, usually gives these elements, based on granulometric analysis. However the adjustment of an infiltration test with clear water is essential to check on site the conformity of the deliveries.

Superiority of 3-dimensional versus 2-dimensional echocardiography for left ventricular volume assessment in small piglet hearts

To evaluate the accuracy of 3-dimensional (3D) echocardiography in the estimation of left ventricular (LV) volume in vivo, we studied 15 newborn piglets ranging in weight from 2.6 to 11.8 kg. Measurements of beating LV volumes by 3D echocardiograms were compared with measurements by conductance catheter and transthoracic 2-dimensional (2D) echocardiograms with the use of Simpson's rule. The results of both 3D and 2D echocardiograms correlated strongly with the actual volume (r = 0.98 and 0.95 for LV end-diastolic volume, and 0.998 and 0.95 for LV end-systolic volume, respectively). However, the standard error of estimate (SEE) for 2D echocardiography was larger than for 3D. The SEE values for LV end-diastolic volume for 2D and 3D echocardiograms were 2.30 mL and 1.85 mL, respectively, and 1.52 mL and 0.5 mL for LV end-systolic volume. We conclude that 3D echocardiography not only accurately measures LV volume and systolic function in a newborn heart, it is more precise than measurements from 2D echocardiography in the assessment of small beating hearts.

Transcatheter closure of atrial septal defects using the Cardio-Seal implant

OBJECTIVE

To review the outcomes of transcatheter closure of atrial septal defects using the Cardio-Seal implant.

DESIGN

A prospective interventional study.

SETTING

Tertiary referral centre.

PATIENTS

The first 50 patients (median age 9.7 years) who underwent attempted percutaneous occlusion.

INTERVENTIONS

Procedures were done under general anaesthesia and transoesophageal guidance between December 1996 and July 1998.

MAIN OUTCOME MEASURES

Success of deployment, complications, and assessment of right ventricular end diastolic diameter, septal wall motion, and occlusion status by echocardiography.

RESULTS

The median balloon stretched diameter was 14 mm. Multiple atrial septal defects were present in 11 patients (22%) and a deficient atrial rim (< 4 mm) in 19 (38%). In four patients (8%), a second device was implanted after removal of an initially malpositioned first implant. There were no significant immediate complications. All patients except one were discharged within 24 hours. At the latest follow up (mean 9.9 months) a small shunt was present in 23 patients (46%), although right ventricular end diastolic dimensions (mean (SD)) corrected for age decreased from 137 (29)% to 105 (17)% of normal, and septal motion abnormalities normalised in all but one patient. No predictors for a residual shunt were identified. Supporting arm fractures were detected in seven patients (14%) and protrusion of one arm through the defect in 16 (32%), the latter being more common in those with smaller anterosuperior rims. No untoward effects resulted from arm fractures or protrusion. There were no complications during follow up, although five patients (10%) experienced transient headaches.

CONCLUSIONS

The implantation of the Cardio-Seal device corrects the haemodynamic disturbances secondary to the right ventricular volume overload, with good early outcome.

Dynamic morphology of the secundum atrial septal defect evaluated by three dimensional transoesophageal echocardiography

OBJECTIVE

To define by three dimensional echocardiography the pattern and potential determinants of contraction of a secundum atrial septal defect through the cardiac cycle, and to evaluate the possibility of using cross sectional transthoracic and transoesophageal imaging to assess the dynamic nature of the defect.

DESIGN

Three dimensional echocardiography was performed using a multiplane transoesophageal probe on 50 patients with a secundum atrial septal defect (median age 9.8 years). Nine patients were excluded because of poor images or morphological features that precluded defect measurement. In 41 cases, defect area, long and short axis length, and distance of the attenuated anterior rim were measured in their largest and smallest dimensions.

RESULTS

Defect area changed significantly through the cardiac cycle (mean change 61%, p < 0.0001; range 17% to 86%). The defect contracted symmetrically and was not related to patient age, defect size, heart rate, Qp/Qs ratio, the presence of an aneurysmal atrial septum, or attenuated anterior rim. In all cases with an attenuated anterior rim (n = 13), the length of the rim significantly decreased (p = 0. 001) during atrial systole. Dynamic changes measured by either transthoracic or transoesophageal cross sectional images did not correlate with those obtained by three dimensional imaging.

CONCLUSIONS

Three dimensional echocardiography shows dynamic features of defects in the atrial septum. This information may lead to an improved understanding of the pathophysiology of atrial shunting.